Workers Comp Electronic Claims Submission Required as of July 1, 2021

April 16, 2021

In an effort to increase health care provider participation in the workers' compensation system, improve injured workers' access to timely, quality medical care, and reduce the administrative burden for providers currently participating in the workers’ compensation system the NYS Workers' Compensation Board (WCB) will consolidate and eliminate certain medical billing forms.

This will be accomplished by converting to the CMS-1500 form, the universal claim form used by medical providers to bill the Centers for Medicare and Medicaid Services (CMS) as well as health insurers.

The Board will replace the following forms with the CMS-1500:

  • Doctor's Initial Report (Forms C-4, EC-4)
  • Continuation to Carrier/Employer Billing Section (Form C-4.1)
  • Doctor's Progress Report (Forms C-4.2, EC-4.2)
  • Ancillary Medical Report (Forms C-4AMR, EC-4AMR)
  • Doctor's Narrative Report (Form EC-4NARR)

 

Starting July 1, 2021 electronic submission of workers’ compensation claims on the CMS-1500 will be mandatory. There are a number of prerequisites and requirements that MCA will assist with in preparation for the July 1, 2021 mandatory start date. Those requirements include:

 

  • Ensuring all providers who see workers’ compensation patients are enrolled with the WCB
  • Executing new agreements with the WCB for submission of the CMS-1500 and associated relevant reports
  • Identifying current workers’ compensation and no fault carriers
  • Identifying current workers’ compensation patients

 

In the next few weeks MCA will contact your office to explain this in more detail and work with you and your office staff during the conversion to the CMS-1500 and electronic claim submission.

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